Budgetzwänge: Ungleichbehandlung von Berufs- und Freizeitsportlern in der Kassenarztpraxis
Die Zahl der sportlich aktiven Menschen nimmt ständig zu, die Freizeitgesellschaft fordert immer mehr und immer intensivere sportliche Betätigung und fordert so auch ihren “Tribut”. Die Zahl der Sportverletzungen steigt stetig. Hier sind Bagatell-verletzungen ebenso häufig wie schwere Gelenk- und Muskelverletzungen durch oder bei der sportlichen Betätigung. Tritt eine solche Verletzung auf, so sind die meisten Sportler mit der Erstbehandlung vertraut:
R est
I ce
C ompression
E levation
Die Erstbehandlung ist einfach, kostengünstig und bei den Profis wie auch den Amateuren identisch. Dann allerdings beginnt für manchen Freizeitsportler das Problem. Der Profi wird noch am Tag der Verletzung oder spätestens am Tag danach durch die diagnostische “Mühle” gedreht, wobei keine Kosten gescheut werden: Röntgen, Ultraschall, Kernspintomographie, Konsiliaruntersuchungen von Neurologe und anderen sind dabei kein Problem. Der Freizeitsportler wird zunächst auch klinisch und radiologisch untersucht, die Ultraschalluntersuchung ebenfalls – wenn erforderlich – immer durchgeführt. Beim MRT (Magnet-Resonanz-Tomographie) wird bereits die Notwendigkeit streng geprüft. Die Termine sind allerdings in keinem Fall so schnell zu bekommen wie beim Profi.
Ist die Verletzung in ihrem Ausmaß diagnostiziert und beginnt die konservative Behandlung, so beginnen für den gesetzlich versicherten Sportler – aber vor allem auch für den behandelnden Kassenarzt – die Probleme. Das Problemwort heißt “Budget”. Die kassenärztliche Therapie ist durch ein Budget reglementiert, das sich sowohl auf die Verordnung von Arzneimitteln als auch auf die Verordnung von krankengymnastisch-physikalischen Maßnahmen bezieht. Können derzeit noch diagnostische Verfahren wie das MRT nach ärztlicher Überzeugung eingesetzt werden, so muß bei der Verordnung von Medikamenten sehr streng auf die Einhaltung der Arzneimittelbudgets geachtet werden.
Die bei den Leistungssportlern angewendeten Therapeutika wie zum Beispiel Enzyme, Zink, Vitamin E oder die Injektionslösungen pflanzlicher Herkunft und das oft so gerne zitierte “Kälberblut” bei der Muskelverletzung stehen für einen gesetzlich Versicherten verletzten Sportler nicht zur Verfügung. Werden diese Substanzen dennoch verordnet, so geschieht dies auf Kosten des Arztes oder des Patienten – nicht auf Kosten der Krankenkasse des Patienten .
Gleichzeitig muß auch der Faktor “Zeit” in der Heilung berücksichtigt werden. Der Kassenarzt wird immer wieder mit den Vorgaben aus dem Profisport konfrontiert. Oft klagen Freizeitsport: Der Sportler X war nach derselben Verletzung nach 14 Tagen wieder im Wettkampf, “ich kann noch gar nicht richtig trainieren”. Meist werden hierbei der Trainingszustand des Sportlers, der wesentlich bessere Ausgangsbedingungen für die Rehabilitation bietet als der des Freizeitsportlers, ebenso vergessen wie die Intensität der Akut- und Nachbehandlung. Während ein Profisportler täglich bis zu acht Stunden an seiner Rehabilitation arbeitet, ist es das Primärziel in einer kassenärztlichen Praxis, den Freizeitsportler wieder arbeitsfähig und erst in zweiter Linie wettkampffähig zu machen.
Aus diesem Grund kann der Freizeitsportler das Therapieprogamm nicht wie ein Profisportler gestalten – die Dauer der Rehabilitation ist wesentlich länger. Zudem stehen nur zeitlich begrenzte therapeutische Maßnahmen zur Verfügung, die natürlich auch den Budgetzwängen unterliegen . Der Physiotherapeut, der den verletzten Freizeitsportler behandelt, muß versuchen, möglichst viele Patienten in seiner Praxis zu behandeln, da nur dann die Physiotherapie-Praxis kostendeckend oder gewinnbringend arbeiten kann. Der Physiotherapeut, der den Leistungssportler wieder “fit” macht, kann kosten, was er will und muß sich weitgehend auf diesen Sportler konzentrieren. Hauptsache der Wirtschaftsfaktor “Sportler” ist schnell wieder in seinem Sport zurück. Verein, Sponsoren und Medien sind zufrieden.
Auch in der postoperativen Behandlung zum Beispiel nach einer vorderen Kreuzbandplastik am Kniegelenk tun sich große Unterschiede auf. Der Profi rehabilitiert in einem speziellen Zentrum oder einer Klinik unter stationären Bedingungen. Für den gesetzlich Versicherten sind die stationären Aufenthalte nicht möglich, da die Rentenversicherungsträger als Kostenträger diese Operation (Kreuzbandplastik) aus dem Indikationskatalog gestrichen haben.
Die ambulante Reha als kassenärztlicher Weg der Rehabilitation nach einer Sportverletzung mit Kreuzbandruptur muß erst durch den Medizinischen Dienst der Krankenkasse genehmigt werden. Dies dauert – je nach Kasse – bis zu vier Wochen, wertvolle Zeit die der Rehabilitation fehlt. Dann werden regelhaft statt der verordneten zum Beispiel 24 Therapieeinheiten nur 12 genehmigt, die Intensität der Rehabilitation wird dadurch nochmals reduziert. Stellt man dann den Verlängerungsantrag, muß auch der wieder genehmigt werden. Oft wird er abgelehnt, weil ja jetzt schon mehr als sechs Wochen nach der Operation vergangen sind und normale Krankengymnastik (25 Minuten) ausreichend sein müßte.
So versuchen alle Seiten, die Kosten zu reduzieren, die durch die Vielzahl der Behandelten und die Zunahme der diagnostischen und therapeutischen Möglichkeiten ständig steigen. Der Kassenarzt ist aus diesem Grund gar nicht so glücklich, einen anspruchsvollen, gesetzlich versicherten Sportler mit einer intensiv therapiebedürftigen Sportverletzung zu behandeln – und dies vielleicht auch noch erfolgreich! Denn bei den Sportlern ist die Mundpropaganda sehr intensiv und der kassenärztlich tätige Sportmediziner hat dann das Problem, immer mehr Sportverletzte zur Therapie zu bekommen – und dann entweder draufzuzahlen oder die Therapie umzustellen. Dann wird aber auch der Erfolg ausbleiben.
Volkswirtschaftlich betrachtet ist die Zunahme der Sportverletzungen, auch der Bagatellverletzungen, ein Fiasko, denn die Kosten für eine adäquate Therapie sprengen jedes Budget und können nur bei den Profisportlern durch die Berufsgenossenschaften oder die Vereine aufgebracht werden. Der gesetzlich versicherte Patient muß das Glück haben, einen engagierten Sportmediziner mit entsprechend großem Arzneimittelschrank als Therapeuten zu haben oder – und das ist die Regel – einen längeren Heilungsprozess akzeptieren.
20. August 2002
Dr. med. Michael Krüger-Franke, München
Wow, awesome weblog structure! How lengthy have you been running a blog for?
you made running a blog glance easy. The entire look of your website
is excellent, as neatly as the content! You can see similar here najlepszy sklep
My coder is trying to persuade me to move to .net from PHP.
I have always disliked the idea because of the expenses. But he’s tryiong none the
less. I’ve been using Movable-type on various websites for about a year and am concerned about switching to another platform.
I have heard very good things about blogengine.net. Is there a
way I can transfer all my wordpress content into it? Any kind of help would be greatly appreciated!
I saw similar here: Sklep
Hi there! Do you know if they make any plugins to assist with SEO?
I’m trying to get my blog to rank for some targeted keywords
but I’m not seeing very good results. If you know of
any please share. Cheers! You can read similar art here: Sklep internetowy
It’s very interesting! If you need help, look here: ARA Agency
Hi! Do you know if they make any plugins to help with Search Engine Optimization?
I’m trying to get my site to rank for some targeted keywords but I’m not seeing
very good success. If you know of any please share.
Kudos! You can read similar article here: Auto Approve List
I always look forward to your new posts. You have a way of making even the most complex topics easy to understand. Excellent job!swiftnook
This post was incredibly informative and well-organized. I learned so much from reading it. Thank you for your hard work and dedication!rendingnicheblog
What would we do without the brilliant tips you discuss on this website? Who else has got the persistence to deal with important topics in the interest of common readers like me? My spouse and i and my friends are very blessed to have your web site among the types we often visit. We hope you know how considerably we love your effort! Best wishes through us all.
Some really nice stuff on this web site , I love it.
The elegance of those blogging engines and CMS platforms may be the lack of limitations and ease of manipulation that permits builders to put into action prosperous subject material and ‘skin’ the site in this kind of a way that with really little effort a single would in no way observe what it truly is generating the website tick all without having limiting content and effectiveness.
??? ????? ????? ????? ???? ?? ????? ?? ????? ??? ?? ?????? ??????? . ????? ??????? ????? ???? ?????? ??????? ?????? ??????? ???? ????? ?????? ??????? ??? ??????? ??? ?? ??????? ?? ????? ????????.
Basically to follow up on the up-date of this topic on your web site and wish to let you know simply how much I loved the time you took to generate this valuable post. Within the post, you really spoke of how to actually handle this matter with all ease. It would be my pleasure to collect some more ideas from your web page and come as much as offer other people what I learned from you. Many thanks for your usual terrific effort.
Hi I knew i had seen this website before… This guy made a exact copy of your site. Or maybe this is also your site?
An intriguing discussion is worth comment. I do believe that you can write more on this topic, it will not become a taboo subject but generally individuals are there are not enough to communicate in on such topics. To another location. Cheers
my voice sucks on karaoke that is why i am taking sining lessons now from professionals*
best suvs… […]we like to honor other sites on the web, even if they aren’t related to us, by linking to them. Below are some sites worth checking out[…]…
You can increase your blog visitors by having a fan page on facebook.:’*”~
There are a couple of interesting points soon enough in this posting but I don’t determine if I see these center to heart. You can find some validity but Let me take hold opinion until I investigate it further. Good write-up , thanks so we want much more! Put into FeedBurner at the same time
Howdy sir, you have a really nice blog layout .
It never had the objective in being the perfect movie, but in terms of sheer entertainment, this one succeeded tremendously.
This is a fantastic article. Thanks for bothering to detail all of this out for us. It really is a great guide!
oh my Daryl Hannah is quite a tall girl, i just seen here last month`
An exceptionally good post. This information sums up for me what this topic depends upon and some of the essential benefits that can be created from knowing about it as you. A friend once remarked that you have a totally different perspective when you do something for certain as opposed to when you’re just toying with it. In the case of this topic, I believe you are taking, or start to consider, a more professional in addition to thorough approach to either what and how you write, which in turn helps you to carry on and get better and help others who don’t know everything about what you have discussed here. Thank you.
This sort of thing needs to happen! Simply letting the quota happen isn’t acceptable. This will help you stay above the curve.
Hello there! Do you know if they make any plugins to assist with SEO?
I’m trying to get my blog to rank for some targeted keywords
but I’m not seeing very good gains. If you know of any please share.
Thank you! You can read similar blog here: Good escape room
I, on behalf of my friends in the school, wish to express all of our thanks for the truly wonderful secrets revealed by means of your article. The clear explanation brought comfort and hope to all of us and would probably really help us with a research we are currently doing. I think if still come across websites like yours, my own stay in college will be an easy one. Thank you
Hello! I merely wish to give you a large thumbs up with the excellent information you have here about this post. I am coming back to your blog post for much more soon.
Having read this I believed it was extremely enlightening. I appreciate you finding the time and effort to put this content together. I once again find myself personally spending a lot of time both reading and posting comments. But so what, it was still worthwhile!
i operate a small computer shop at home and most customers enjoy playing online games,.
In this grand pattern of things you’ll get an A just for hard work. Exactly where you confused me personally was first on your specifics. As people say, the devil is in the details… And that could not be more accurate here. Having said that, permit me say to you precisely what did deliver the results. Your text is actually highly engaging and that is probably why I am making an effort to comment. I do not make it a regular habit of doing that. Second, although I can easily see the leaps in reason you come up with, I am not convinced of exactly how you seem to connect your details which help to make the conclusion. For now I will yield to your position however wish in the foreseeable future you link your facts much better.
I’ll right away grab your rss as I can’t find your e-mail subscription hyperlink or e-newsletter service. Do you’ve any? Please let me understand in order that I may subscribe. Thanks!
I believe one of your advertisings triggered my internet browser to resize, you might want to put that on your blacklist.
Hi! Do you know if they make any plugins to safeguard against hackers? I’m kinda paranoid about losing everything I’ve worked hard on. Any tips?
You got a very great website, Glad I discovered it through yahoo.
dog houses need not be elegant, it only needs to be a design that makes it easier for us to clean.
Oh my goodness! Amazing article dude! Thank you so much, However I am going through problems with your RSS. I don’t know why I am unable to join it. Is there anybody else getting similar RSS problems? Anyone who knows the answer can you kindly respond? Thanks!!
This web-site can be a walk-through rather than the information you wished about it and didn’t know who must. Glimpse here, and you’ll definitely discover it.
After study a few of the content on your own website now, and i also truly as if your strategy for blogging. I bookmarked it to my bookmark site list and you will be checking back soon. Pls look into my internet site as well and told me what you think.
Having read this I believed it was extremely informative. I appreciate you finding the time and energy to put this information together. I once again find myself spending a significant amount of time both reading and commenting. But so what, it was still worthwhile.
Spot on with this write-up, I really feel this web site needs much more attention. I’ll probably be back again to read more, thanks for the advice.
You’re so awesome! I do not believe I’ve truly read through a single thing like that before. So nice to find another person with genuine thoughts on this subject. Seriously.. many thanks for starting this up. This website is one thing that’s needed on the web, someone with a bit of originality.
Good post. I will be facing a few of these issues as well..
Hey there! Do you know if they make any plugins to help with Search Engine Optimization?
I’m trying to get my blog to rank for some targeted keywords but I’m not seeing very good
results. If you know of any please share.
Thanks! You can read similar blog here
Everything is very open with a very clear explanation of the issues. It was really informative. Your site is very useful. Thank you for sharing!
Hello! I’ve been reading your web site for some time now and finally got the bravery to go ahead and give you a shout out from Humble Tx! Just wanted to say keep up the good job!
Excellent! I thank you your blog post to this matter. It has been useful. my blog: how to get a six pack
Pretty nice post, I was doing a google search and your site came up for short sales in Winter Park, FL, Orlando, FL but anyway, I have had a pleasant time reading it, keep it up!
Way cool! Some extremely valid points! I appreciate you penning this article plus the rest of the website is very good.
After I initially left a comment I seem to have clicked the -Notify me when new comments are added- checkbox and now every time a comment is added I receive four emails with the exact same comment. There has to be a means you are able to remove me from that service? Kudos.
I like the posts on this site… I’ll be coming back for sure.
I really like forgathering useful info, this post has got me even more info! .
online computers stores that offers good technical support are the best..
I always was concerned in this subject and stock still am, appreciate it for putting up.
I do trust all the ideas you’ve introduced on your post. They’re really convincing and will definitely work. Nonetheless, the posts are very quick for starters. May just you please extend them a bit from subsequent time? Thanks for the post.
Your blog is amazing dude. i love to visit it everyday. very nice layout and content .
You ought to take part in a contest for one of the finest sites on the net. I am going to highly recommend this site!
Ten post to świetne źródło informacji dla każdego, kto potrzebuje SEO.
Bardzo pouczający post o SEO. Cieszę się, że to przeczytałem przed rozpoczęciem jakichkolwiek działań.
Ten post był bardzo pouczający na temat procesu SEO. Dzięki!
Ten post to świetne źródło informacji dla każdego, kto potrzebuje SEO.
Wskazówki dotyczące bezpieczeństwa SEO są bezcenne. Dziękuję za ich udostępnienie!
Think about this: Never put all your eggs in one basket.
Hello,i can see that you are a really great blogger,
This is so good to see. We have do more things like this for the military families. They are protecting us and we need to support them in this way
i love to use memory foams because they are soft and they can make impressions;
When I originally commented I clicked the -Notify me when new comments are added- checkbox and from now on each time a comment is added I buy four emails with similar comment. Can there be any way it is possible to get rid of me from that service? Thanks!
Now i am really fresh to wordpress blogs. however what you post on this site is absolutely very good and very beneficial. I believe it would help me in the future. Thanks for the excellent work.
Your passion for this topic is evident.에볼루션 바카라 가라머니
An outstanding share! I have just forwarded this onto a friend who had been doing a little research on this. And he in fact ordered me lunch simply because I discovered it for him… lol. So let me reword this…. Thank YOU for the meal!! But yeah, thanx for spending some time to discuss this subject here on your site.
An impressive share! I’ve just forwarded this onto a co-worker who had been doing a little homework on this. And he actually bought me breakfast due to the fact that I stumbled upon it for him… lol. So allow me to reword this…. Thank YOU for the meal!! But yeah, thanx for spending the time to talk about this topic here on your internet site.
Wonderful article! We will be linking to this particularly great content on our site. Keep up the good writing.
Excellent site you have here.. It’s hard to find high-quality writing like yours nowadays. I truly appreciate individuals like you! Take care!!
An intriguing discussion is definitely worth comment. I believe that you should publish more about this subject, it may not be a taboo subject but usually people don’t speak about such issues. To the next! Cheers.
Everything is very open with a clear clarification of the issues. It was truly informative. Your site is useful. Thank you for sharing!
Hello! I could have sworn I’ve been to this web site before but after browsing through a few of the posts I realized it’s new to me. Regardless, I’m definitely pleased I came across it and I’ll be bookmarking it and checking back often.
Hi there! I simply wish to give you a big thumbs up for the excellent info you have got here on this post. I will be coming back to your site for more soon.
Everyone loves it when folks get together and share opinions. Great website, continue the good work!
You’ve provided a fresh take on this issue.카카오 대출
Your passion for this topic is evident.중소기업 대출
Your perspective adds a lot to the conversation.프라그마틱 무료 슬롯버프
Your post is a valuable contribution to this field.백링크
The very next time I read a blog, Hopefully it doesn’t disappoint me just as much as this one. After all, Yes, it was my choice to read, but I genuinely believed you would have something helpful to say. All I hear is a bunch of moaning about something that you can fix if you were not too busy seeking attention.
Everything is very open with a clear clarification of the challenges. It was definitely informative. Your website is very useful. Thanks for sharing.
This would be the appropriate blog for everyone who really wants to discover this topic. You understand a great deal its virtually difficult to argue to you (not too I personally would want…HaHa). You actually put the latest spin over a topic thats been written about for several years. Great stuff, just excellent!
of course above ground pools are easier to maintain and to clean*
This site really has all of the information I wanted concerning this subject and didn’t know who to ask.
Your style is unique compared to other folks I have read stuff from. Many thanks for posting when you’ve got the opportunity, Guess I will just book mark this page.
Very good article! We are linking to this particularly great content on our site. Keep up the great writing.
https://artdaily.com/news/171650/Mp3Juice-Review–The-Pros-and-Cons-You-Need-to-Know
Aw, this was a really nice post. Finding the time and actual effort to generate a good article… but what can I say… I put things off a whole lot and never seem to get anything done.
Spot on with this write-up, I actually believe that this amazing site needs a great deal more attention. I’ll probably be returning to see more, thanks for the info.
Hi, I do believe this is a great blog. I stumbledupon it 😉 I am going to return once again since i have book marked it. Money and freedom is the best way to change, may you be rich and continue to guide others.
This site definitely has all of the information and facts I wanted about this subject and didn’t know who to ask.
Good post. I learn something new and challenging on blogs I stumbleupon everyday. It will always be exciting to read articles from other writers and practice something from their web sites.
I like it whenever people get together and share views. Great site, keep it up!
I really like reading an article that can make men and women think. Also, many thanks for permitting me to comment.
Greetings! Very useful advice within this post! It’s the little changes that produce the most important changes. Thanks for sharing!
That is a really good tip especially to those new to the blogosphere. Simple but very accurate info… Thank you for sharing this one. A must read article!
Excellent web site you have got here.. It’s hard to find quality writing like yours these days. I seriously appreciate individuals like you! Take care!!
You’ve made this topic accessible to everyone.검색엔진최적화 메타태그
Great article. I’m dealing with some of these issues as well..
I’m going to share this with my network.구글지니어스
Oh my goodness! Impressive article dude! Thank you so much, However I am going through difficulties with your RSS. I don’t understand why I can’t join it. Is there anyone else having identical RSS problems? Anyone that knows the answer will you kindly respond? Thanx.
Great info. Lucky me I discovered your blog by chance (stumbleupon). I’ve book marked it for later.
There is definately a lot to know about this topic. I really like all of the points you’ve made.
Hi there! I just wish to give you a big thumbs up for the excellent information you’ve got here on this post. I will be coming back to your web site for more soon.